Survey Identifies Barriers to Achieving Value-Based Care Models

Value-based care and interoperability continue to progress in the United States, but barriers that limit sharing of clinical information among hospitals, physicians, and health plans remain, according to a study by the Healthcare Financial Management Association (HFMA) and sponsored by Humana.

Three main barriers that slow the progression of value-based care include:

• Adoption of payer value-based programs may be somewhat slower than expected, though they have doubled since 2015.
• External and internal interoperability may be a primary focus of providers in the coming years, due to current shortcomings, anticipated future need, and the increasing demand for access to various sources of data.
• Almost three-fourths of executives (74%) report their organizations have achieved positive financial results (i.e., return on investment) from value-based payment programs to date.

Interoperability between hospitals, physicians, and patients was recognized as extremely important by the respondents. In 2017, half of respondents found interoperability improvement across health networks and recognized health plans as extremely important.

“Interoperability has the challenge of collecting fragmented health data and exchanging the information across multiple systems. In addition, it must provide physicians access to comprehensible patient health information at the right time for informed decision making and better efficiencies. Overcoming the interoperability barrier becomes even more important for treating patients with chronic conditions as they generally see multiple physicians and specialists,” Roy Beveridge, MD, Humana’s chief medical officer, said in a press release.

The main findings from the 2017 study include a 2-fold increase in health plans’ use of value based mechanisms since 2015, as well as penetration of value-based payment in negotiated governmental plans coming in at 26%. The survey also found that 74% of respondents reported their organizations achieved positive financial results from value-based payment programs and 75% of respondents stated regulatory uncertainty, including the Medicare Access and CHIP Reauthorization Act, has a negative effect on their ability to forecast the financial impact of value-based payment.

It was also recognized that more resources and funding must support patients in need of chronic care and patients affected by social determinants. Almost two-thirds (65%) of respondents found that their organizations do not have the tools to assist in specialty or inpatient care to help control costs and 63% of respondents found that their organizations do not consider social determinants of health in planning overall strategy and cost planning.

“Collaboration among health systems, physicians, and health plans is the key to growing value-based payment,” said HFMA President and CEO Joseph J. Fifer, FHFMA, CPA. “Technology and other obstacles can be overcome if all stakeholders commit to working together for the benefit of the people we serve.”